Photo Credit: Deann Barrera
I was only a Nurse's Aide at the nursing home for a little over one month when I saw someone die.
The first week of work wasn't so bad. Here's how you make a bed, here's how you feed pureed peas, here's how you dress them, bathe them, care for them. That was easy. The second week, they took me upstairs to do it on real people. It was harder then. The beds looked sloppy, pureed peas slid down the front of my new Mickey Mouse scrub top, some of them refused to wear clothes at all, none of them liked showers. It was hard to care for the creatures… or to get rid of the guilt I felt for thinking of them like that. But it wasn't until I watched a woman die that I realized just how difficult this job would be.
Her name was Rosemary. She'd recently come to the nursing home from the hospital. She came to die. The other CNAs and I were told to try to make her comfortable. I tried, really I did, but the other CNAs told me that that's what the doctor and nurses tell them as a matter of principle. It's not really possible, especially for a cancer patient like Rosemary.
My grandmother died of cancer just before I turned five. I was too little to go to the Intensive Care Unit, so I sat with Dad in the cafeteria and ate cinnamon ice cream. Later that night, my brother, who was big enough to go to the ICU, told me stories about Grandma and her room. He said that Grandma didn't have any hair. I didn't believe that because Grandma had always had perfect hair—brown and wavy and never tangled like my own dirty blond hair always was. I know now that Grandma wore a wig for almost two years to keep from scaring the grandchildren. He also told me about Grandma's sausage fingers. I giggled at that. He said the medicine made her look all swollen, like a balloon that had taken in one too many breaths. But I hadn't believed that, either.
Then, he told me the scariest part—the thing that caused nightmares for weeks. He told me about the curtains. They were a pastel blue or green, it was hard to tell which. And they were closed. "Nah… no way!" I exclaimed. Grandma had lived on a farm her whole life. She loved the outside, even when she was inside. I had seen her on many occasions sitting in the window seat with a book in her lap. I never saw her actually read. Grandma sat, looking out the window, watching the birds, smiling at squirrels. When I asked her what she was doing, Grandma grinned and said, "Just watching the corn grow!"
He told me that when Mom bent to pray and Grandma closed her puffy eyelids, he went to the curtains and pulled one aside. It was heavier than he thought it would be, but when it finally gave, he lifted his chin and looked through the thick glass. Brick. That's all he saw, he said. Just brick. A window that opened to a wall—no way out. He screamed and started to cry then, so Mom swept him up and took him to the cafeteria for cinnamon ice cream.
When someone dies, the other CNAs told me, you have to open the window or their spirit won't leave the room. That's what they said, but I know now that that wasn't exactly true. It was the smell. It seemed so cliché—The Smell of Death. But it's really there and for once the cliché is accurate. The dying woman had had cancer for so long that it had finished eating up her insides and was munching its way out of her yellowish, waxy body. It made oozing yellow-and-white sores all over her chest and back. The sores had opened one day and never scabbed over. Blood, pus, and life just ran out on the sheets and no matter how many times the sheets were changed and the woman was bathed, the smell of rotten skin and pus never quite left the room.
But when Rosemary died, I was in the room helping the charge nurse change her IV. The nurse had removed the first IV because the wasted woman's vein had collapsed, cutting off her supply of morphine. Now, the nurse was poised with the needle, ready to insert it, but set it down on the bedside table. She frowned and put her fingers on the woman's wrist. Her frown deepened.
"Go get the blood pressure cuff and a stethoscope and tell me if this lady is an orange dot," the nurse said softly.
I jogged to the nurse's station, grabbed the cuff and stethoscope and pulled Rosemary's chart. The orange dot, the Do Not Resuscitate code, was affixed to the front. I looked, then again, then one more time to make sure it was Rosemary's chart and the orange dot wasn't my imagination. As I looked, the realization smacked me in the face. Rosemary was dead.
I called out to Mike, another CNA walking down the opposite hall, and told him to go to room 272 and prepare for post-mortem care. I went to the closet behind the Nurse's Station, unlocked it, and hauled out the EKG machine. I thanked God it wasn't my job to notify the family.
I learned about the procedures you have to go through when someone in a nursing home dies. Death is defined as a lack of vital signs. I searched Rosemary's wrist for any sign of a pulse. I didn't find a pulse, and I tried to ignore Rosemary's eyes as I fit the blood pressure cuff around the limp arm, positioned the stethoscope above the brachial artery, and began pumping. The needle on the dial didn't waver once as it traveled back to zero. I never heard the lub-dub of a heartbeat. I shook my head at the nurse and Mike, who came in during the procedure. He started applying the adhesives from the EKG machine to different parts of Rosemary's body: her wrists, her elbows, her feet.
I looked away and began running water in the sink to get it warm. I looked at myself in Rosemary's mirror. I marveled at how calm I looked, how together I appeared to be when my insides were alternately falling to my feet and then springing back up into my skull. I didn't know whether to laugh or cry.
"Flat line," the nurse said quickly. She and Mike began removing the adhesives. I moved a basin into the sink to catch the now too-warm water, turning on the cold and adding soap. When it was almost full, I threw several washcloths into the basin, grabbed four or five towels and turned to face Mike and Rosemary. The nurse left with the EKG machine to notify the doctor, family, and funeral home.
I took a deep breath, closed my eyes for a little longer than a blink, and stepped forward.
"Are you gonna be okay?" Mike asked. This was unusual. He usually gave me a bunch of crap, but now he seemed sincere.
"Yeah. I think so," I answered. "My first time."
"Oh," Mike responded. "You never forget your first time. I still remember mine. A man named William. Colon cancer."
I smiled thinly and set the basin on the bedside table. Mike pulled Rosemary's hospital gown off as I pulled the sheet up to keep the dead woman covered. I wondered if it mattered. It did.
"Wait!" Mike said. He jogged over to the window and pushed it open.
A blast of cool air hit my face as I raced to the tiny bathroom. I hadn't realized that the Smell was that strong until I breathed fresh air. I fell to my knees and began heaving into the toilet, thinking of all the people who sat there and what they did. I wished I could vomit, but I hadn't had my supper break yet. The cool air was so light. The air near Rosemary was heavy, thick, like breathing melted cheese. I heaved again and again.
After eternity, I wiped my mouth, dried my eyes on my sleeve, went to the sink, washed my hands, put on fresh gloves, and returned to Rosemary. Mike had waited for me.
I began gently washing Rosemary's chest, careful of her sores. Mike washed her face, then put his fingers on her eyelids and held them down. After a few seconds, he removed his fingers. The left eyelid slowly rose again. I, trying not to look at that blue, staring eye, moved on to wash an arm, lifting it oh-so-carefully, and replacing it softly on the bed. Mike washed her other arm. We both got fresh washcloths. We washed her stomach and her legs. Clean washcloths. Feet and in between toes. Clean washcloths. Her vagina. Clean washcloths. Mike rolled Rosemary toward him. Her back. Clean washcloth. Her buttocks. Clean washcloth. The backs of her legs. We were careful to cover whatever we weren't washing and to dry immediately whatever we had washed. Habit, I suppose, nothing more.
But that eye was watching and I didn't want to do anything that would disappoint her.
Neither of us spoke.
Mike rolled her back onto her backside and I went to the closet to get an adult diaper. When someone dies, they lose all muscle control, including control of the sphincter. CNAs put diapers on every dead person, even if they never wore one while alive. We changed the sheets and pillowcase, put a fresh gown on her body and pulled the sheet up to her chest. I raised the head of Rosemary's bed so the face wouldn't discolor before the family viewed the body and Mike succeeded in getting the other eye to stay shut. I combed Rosemary's hair carefully; a difficult task, since it was falling out. Before leaving the room, Mike closed the window. We de-gloved and washed our hands. I sighed and Mike put his arm around my shoulders.
"Don't cry now," he whispered. "If the family comes in, you don't want them to see you cry. You never cry in front of doctors or families."
I felt my chin tremble, but I didn't cry.
I didn't cry.
I cried at my grandmother's funeral, not because I understood death or even recognized the lady in the casket as my grandmother. I was confused about that. It didn't look like Grandma in the casket. Somebody had made a terrible mistake, I had thought.
I cried because I saw my mother cry. When you are only five, mothers are supposed to be strong and supportive. I'd never seen my mother cry. I didn't know that she could. Something terrible must have happened to make Mom cry.
It was wrong, all wrong. Mothers weren't supposed to cry. Mothers are invincible, strong, comforting to others who cry, but never actually crying themselves. I burst into tears then. My two aunts crowded around me, trying to console me with comforting sounds and stories of how we'll all meet again in Heaven. I was crying too hard to tell them that I wasn't crying for Grandma, but for Mom.
It has been two-and-a-half years, since Rosemary died. I have done post-mortem care on an innumerable number of residents in the nursing home. I have even played Mike's role several times, comforting newbies and instructing them as to what is acceptable and what is not. I have never forgotten Rosemary. Or my grandmother. I haven't forgotten the nursing home, or the charge nurse who was with me that day. I will always remember that smell. I even remember the generic name of the funeral home director (John Anderson) who came to "collect the body."
But the thing that sticks out in my mind more often than all of that other stuff is the window. I'm still not sure I believe the story of "open the window or their souls won't leave." I kinda think that maybe the window is more symbolic than anything else. You know, new beginning, a release, whatever you want to call it. Sometimes I go into that room and just look out that window. If it's open, I close it. I look into my own eyes and the trees beyond them. I imagine Rosemary's face there. I imagine Grandma. I see my mother, red-faced, puffy-eyed, helpless.
And, finally, I cry.
Hayley Cooper is a 28-year-old housewife who has had many jobs and many life experiences. She is grateful for these opportunities, as they afford her the possibility of great writing. Hayley studied English at Truman State University in Kirksville, MO, and has had poetry published in a campus-wide magazine. She is also an avid reader with two dogs. Email: cooper.hayley11[at]gmail.com